As of this writing, the
number of people infected is low—but measles is exceptionally contagious. While those who have been vaccinated have an excellent
defense against the disease, the unvaccinated are quite vulnerable. These people
include those too young to get the vaccine and those who have medical reasons
for not getting it. It also includes people who have elected to not have themselves
or their children vaccinated. Washington allows citizens to opt out of vaccination,
which is the reason that the population did not reach the percentage of people
needed to provide herd immunity (that is, so many people are vaccinated, even
the unvaccinated are protected because the disease will be limited in its
ability to spread).

While medical reasons are clearly legitimate reasons
to not get vaccinated, some states allow people to refuse vaccination based on
their religious beliefs. Some states also allow an exception for “philosophical
beliefs” about vaccines. While the legality is a matter for the lawmakers, this
is clearly also an ethical matter.

Proponents of vaccine choice might argue that
vaccines are harmful and hence it is the right choice to opt out, regardless of
whether one is motivated by religion or philosophy. However, the measles
vaccine (like almost all vaccines) is very safe. This is not to say that vaccination
is without risk—they can have serious side effects. However, the risk of the harms
prevented by vaccines greatly outweighs the risk of the vaccines. Also, most worries
about vaccines are based on utterly debunked claims. To use an analogy, the
argument against getting vaccinated is like the old argument about not wearing
a seatbelt. One version of the seatbelt argument is that since a person could
be trapped in a burning wreck, they should not wear their seatbelt because they
will be safer. While there is some tiny
risk in wearing a seatbelt, the risk of injury and death resulting from not
wearing one is far greater—hence wearing a seatbelt is the good choice.
Likewise, for vaccines. As such, except for people who are allergic to a vaccine
or would otherwise really suffer medical harm, the argument that people should opt
out because of the danger has no merit.

Religious and “philosophical” reasons to opt out
of vaccines need not be based on harm or even on any appeal to facts. Even it
the religious or “philosophical” claim could be shown to be false or even impossible,
the justification would remain—after all these justifications are about what
the person thinks, not about what is true. The basic idea is that the
justification to opt out would be the person’s claim that their religion or
belief forbids them from getting vaccinated or having their children
vaccinated. As such, the justification would fall under freedom of religion/belief.

While my commitment to the freedom of belief
entails that I think it is generally wrong to compel people to violate their
beliefs, I accept the obvious fact that freedoms are not limitless. To use an
absurd example, if someone believed sincerely in Cthulhu and wanted to sacrifice
people to their imaginary god, this should not be allowed—freedom of religion
does not grant a right to murder. This does point to a non-absurd point, namely
that the freedom of belief does not grant a freedom to harm others.

To use an analogy, freedom of belief can be seen
as like the freedom to drink alcohol. A person is free to drink as much as they
wish, even if doing so is harmful to themselves or a bad live choice. However,
this does not grant then the freedom to get behind the wheel while drunk. Likewise,
for freedom of belief: a person can believe whatever crazy, false or wicked
thing they wish as long as that belief is not used to try to justify harming
others. While this principle applies obviously to human sacrifice, it also
applies to vaccines.

While a person might argue that they are only
putting themselves at risk when they elect to not have their child vaccinated,
this is obviously not true. They are putting their child and others at risk. To
use an analogy, they would be like parents who claim that the right to drink not
only allows them the right to get drunk, but to go out for a drive with their
kids. This would obviously put their kids and other people at risk—without their
consent. As such, refusing to vaccinate one’s children when the vaccines have
been proven safe and the risk of disease is real is morally unacceptable, no
mater the beliefs of the parents. Beliefs about beer and drunk driving would
not warrant exceptions to forbidding drunk driving, likewise beliefs about
vaccines and disease would not warrant exceptions to vaccination.

It might be objected that adults should have the
choice in their own case. In the case of vaccinations against diseases that do
not spread (like shingles), there is no moral reason to forbid people from
opting out—they are only putting themselves at risk. But, going back to the
drunk driving analogy, it would obviously be wrong for a drunk adult to go
driving even if they had no kids or left them at home. Naturally, if a person or
group is willing to isolate themselves and have no contact with anyone else, then
they would be free to vaccinate or not—this would be analogous to people
agreeing to drive drunk together on private roads. It would be a stupid idea,
but as long as everyone provides informed consent, then it would be morally
acceptable. Of course, this would still not justify opting out on vaccinations
for children—they cannot provide informed consent and accept the risk.

Based on the above arguments, allowing people to
opt out of vaccines based on beliefs is immoral and should not be permitted.

Like this:

Poster from before the 1979 eradication of smallpox, promoting vaccination. (Photo credit: Wikipedia)

The United States recently saw an outbreak of the measles (644 cases in 27 states) with the overwhelming majority of victims being people who had not been vaccinated. Critics of the anti-vaccination movement have pointed to this as clear proof that the movement is not only misinformed but also actually dangerous. Not surprisingly, those who take the anti-vaccination position are often derided as stupid. After all, there is no evidence that vaccines cause the harms that the anti-vaccination people refer to when justifying their position. For example, one common claim is that vaccines cause autism, but this seems to be clearly untrue. There is also the fact that vaccinations have been rather conclusively shown to prevent diseases (though not perfectly, of course).

It is, of course, tempting for those who disagree with the anti-vaccination people to dismiss them uniformly as stupid people who lack the brains to understand science. This, however, is a mistake. One reason it is a mistake is purely pragmatic: those who are pro-vaccination want the anti-vaccination people to change their minds and calling them stupid, mocking and insulting them will merely cause them to entrench. Another reason it is a mistake is that the anti-vaccination people are not, in general, stupid. There are, in fact, grounds for people to be skeptical or concerned about matters of health and science. To show this, I will briefly present some points of concern.

One point of rational concern is the fact that scientific research has been plagued with a disturbing amount of corruption, fraud and errors. For example, the percentage of scientific articles retracted for fraud is ten times what it was in 1975. Once lauded studies and theories, such as those driving the pushing of antioxidants and omega-3, have been shown to be riddled with inaccuracies. As such, it is hardly stupid to be concerned that scientific research might not be accurate. Somewhat ironically, the study that started the belief that vaccines cause autism is a paradigm example of bad science. However, it is not stupid to consider that the studies that show vaccines are safe might have flaws as well.

Another matter of concern is the influence of corporate lobbyists on matters relating to health. For example, the dietary guidelines and recommendations set forth by the United States Government should be set on the basis of the best science. However, the reality is that these matters are influenced quite strongly by industry lobbyists, such as the dairy industry. Given the influence of the corporate lobbyists, it is not foolish to think that the recommendations and guidelines given by the state might not be quite right.

A third point of concern is the fact that the dietary and health guidelines and recommendations undo what seems to be relentless and unwarranted change. For example, the government has warned us of the dangers of cholesterol for decades, but this recommendation is being changed. It would, of course, be one thing if the changes were the result of steady improvements in knowledge. However, the recommendations often seem to lack a proper foundation. John P.A. Ioannidis, a professor of medicine and statistics at Stanford, has noted “Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome. In this literature of epidemic proportions, how many results are correct?” Given such criticism from experts in the field, it hardly seems stupid of people to have doubts and concerns.

There is also the fact that people do suffer adverse drug reactions that can lead to serious medical issues and even death. While the reported numbers vary (one FDA page puts the number of deaths at 100,000 per year) this is certainly a matter of concern. In an interesting coincidence, I was thinking about this essay while watching the Daily Show on Hulu this morning and one of my “ad experiences” was for Januvia, a diabetes drug. As required by law, the ad mentioned all the side effects of the drug and these include some rather serious things, including death. Given that the FDA has approved drugs with dangerous side effects, it is hardly stupid to be concerned about the potential side effects from any medicine or vaccine.

Given the above points, it would certainly not be stupid to be concerned about vaccines. At this point, the reader might suspect that I am about to defend an anti-vaccine position. I will not—in fact, I am a pro-vaccination person. This might seem somewhat surprising given the points I just made. However, I can rationally reconcile these points with my position on vaccines.

The above points do show that there are rational grounds for taking a general critical and skeptical approach to matters of health, medicine and science. However, this general skepticism needs to be properly rational. That is, it should not be a rejection of science but rather the adoption of a critical approach to these matters in which one considers the best available evidence, assesses experts by the proper standards (those of a good argument from authority), and so on. Also, it is rather important to note that the general skepticism does not automatically justify accepting or rejecting specific claims. For example, the fact that there have been flawed studies does not prove that the specific studies about vaccines as flawed. As another example, the fact that lobbyists influence the dietary recommendations does not prove that vaccines are harmful drugs being pushed on Americans by greedy corporations. As a final example, the fact that some medicines have serious and dangerous side effects does not prove that the measles vaccine is dangerous or causes autism. Just as one should be rationally skeptical about pro-vaccination claims one should also be rationally skeptical about anti-vaccination claims.

To use an obvious analogy, it is rational to have a general skepticism about the honesty and goodness of people. After all, people do lie and there are bad people. However, this general skepticism does not automatically prove that a specific person is dishonest or evil—that is a matter that must be addressed on the individual level.

To use another analogy, it is rational to have a general concern about engineering. After all, there have been plenty of engineering disasters. However, this general concern does not warrant believing that a specific engineering project is defective or that engineering itself is defective. The specific project would need to be examined and engineering is, in general, the most rational approach to building stuff.

So, the people who are anti-vaccine are not, in general, stupid. However, they do seem to be making the mistake of not rationally considering the specific vaccines and the evidence for their safety and efficacy. It is quite rational to be concerned about medicine in general, just as it is rational to be concerned about the honesty of people in general. However, just as one should not infer that a friend is a liar because there are people who lie, one should not infer that a vaccine must be bad because there is bad science and bad medicine.

Convincing anti-vaccination people to accept vaccination is certainly challenging. One reason is that the issue has become politicized into a battle of values and identity. This is partially due to the fact that the anti-vaccine people have been mocked and attacked, thus leading them to entrench and double down. Another reason is that, as argued above, they do have well-founded concerns about the trustworthiness of the state, the accuracy of scientific studies, and the goodness of corporations. A third reason is that people tend to give more weight to the negative and also tend to weigh potential loss more than potential gain. As such, people would tend to give more weight to negative reasons against vaccines and fear the alleged dangers of vaccines more than they would value their benefits.

Given the importance of vaccinations, it is rather critical that the anti-vaccination movement be addressed. Calling people stupid, mocking them and attacking them are certainly not effective ways of convincing people that vaccines are generally safe and effective. A more rational and hopefully more effective approach is to address their legitimate concerns and consider their fears. After all, the goal should be the health of people and not scoring points.